Medknow Publications on behalf of the Association of Radiation Oncologists of India (AROI)
Abstract
Purpose: To investigate feasibility and safety of GliaSite
brachytherapy for treatment of central nervous system (CNS) tumors
following neurosurgical resection. We report mature results of
long-term follow-up, outcomes and toxicity. Materials and Methods: In
the period from 2004 to 2007, 10 consecutive adult patients with
recurrent, newly diagnosed, and metastatic brain malignancies underwent
GliaSite brachytherapy following maximally safe neurosurgical
resection. While 6/10 (60%) patients were treated for recurrence,
having previously been treated with external beam radiotherapy (EBRT),
4/10 (40%) received radiotherapy (RT) for the first time. A median dose
of 52.0 Gy (range, 45.0 - 60.0 Gy) was prescribed to 0.5 cm - 1.0 cm
from the balloon surface. Radiation Therapy Oncology Group (RTOG)
criteria were used to assess toxicities associated with this technique.
Follow-up was assessed with MRI scans and was available on all enrolled
patients. Results: Median follow-up was 38 months (range, 18 - 57
months). Mean size of GliaSite balloon was 3.4 cm (range, 2.0 - 4.0
cm). Median survival was 14.0 months for the entire cohort after the
treatment. The 17.6 and 16.0 months average survival for newly
diagnosed and recurrent high grade gliomas (HGG), respectively,
translated into a three-month improvement in survival in patients with
newly diagnosed HGG compared to historical controls (P = 0.033). There
were no RTOG grades 3 or 4 acute or late toxicities. Follow-up magnetic
resonance imaging (MRI) imaging did not identify radiation necrosis.
Conclusions: Our data indicate that treatment with GliaSite
brachytherapy is feasible, safe and renders acceptable local control,
acute and long-term toxicities. We are embarking on testing larger
numbers of patients with this treatment modality